ArticleLancet regional health. Americas2021
Estimating under-recognized COVID-19 deaths, United States, march 2020-may 2021 using an excess mortality modelling approach.
Article in Lancet regional health. Americas, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 1 of them a synthesis that pooled it.
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Who cites it
47 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis.Frontiers in medicine · 2022Pooled it
- Classifying healthcare facilities as predictors of COVID-19 mortality rates in US counties (2020-2021).Journal of public health (Oxford, England) · 2026Article
- Sex differences in excess mortality during the COVID-19 pandemic: a longitudinal ecological analysis of 34 high-income countries.EClinicalMedicine · 2026Article
- Global Estimates of COVID-19 Morbidity and Mortality: A Cohort Study and Mathematical Model Analysis.Influenza and other respiratory viruses · 2025Article
- Minimal Impact of COVID-19 on One-Year Mortality on US Patients with Cancer Diagnosed Early during the Pandemic.Cancer research communications · 2025Article
- Remote Patient Monitoring for Global Emergencies: Case Study in Patients With COVID-19.JMIR formative research · 2025Article
- A Bayesian spatial-temporal varying coefficients model for estimating excess deaths associated with respiratory infections.Journal of the Royal Statistical Society. Series A, (Statistics in Society) · 2025Article
- Excess Deaths in California During the COVID-19 Pandemic, by Healthy Places Index Quartile, February 2020-April 2022.Public health reports (Washington, D.C. : 1974) · 2025Article
- The COVID-19 syndemic: a perfect storm for the life expectancy of the most disadvantaged Americans.International journal of epidemiology · 2025Article
- Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study.JMIR public health and surveillance · 2024Observational
- COVID-19 Death Determination Methods, Minnesota, USA, 2020-2022Emerging infectious diseases · 2024Article
- Spatial Variation in Excess Mortality Across Europe: A Cross-Sectional Study of 561 Regions in 21 Countries.Journal of epidemiology and global health · 2024Article
- Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic.World journal of gastroenterology · 2024Article
- Spatial disparities in the mortality burden of the covid-19 pandemic across 569 European regions (2020-2021).Nature communications · 2024Article
- Public interest trends for COVID-19 and pandemic trajectory: A time-series analysis of US state-level data.PLOS digital health · 2024Article
- Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
- The Role of COVID-19 in Excess Mortality in Slovakia: A Novel Approach Based on Healthcare Billing Records.International journal of public health · 2024Article
- Estimating subnational excess mortality in times of pandemic. An application to French départements in 2020.PloS one · 2024Article
- Using Public Funeral and Obituary Listings to Identify Spikes in Excess Mortality in One Appalachian County.Journal of Appalachian health · 2024Article
- Accuracy of the Verbal Autopsy questionnaire in the diagnosis of COVID-19 deaths in a Brazilian capital.Revista do Instituto de Medicina Tropical de Sao Paulo · 2024Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn the United States, Coronavirus Disease 2019 (COVID-19) deaths are captured through the National Notifiable Disease Surveillance System and death certificates reported to the National Vital Statistics System (NVSS). However, not all COVID-19 deaths are recognized and reported because of limitations in testing, exacerbation of chronic health conditions that are listed as the cause of death, or delays in reporting. Estimating deaths may provide a more comprehensive understanding of total COVID-19-attributable deaths.
methodsWe estimated COVID-19 unrecognized attributable deaths, from March 2020-April 2021, using all-cause deaths reported to NVSS by week and six age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years) for 50 states, New York City, and the District of Columbia using a linear time series regression model. Reported COVID-19 deaths were subtracted from all-cause deaths before applying the model. Weekly expected deaths, assuming no SARS-CoV-2 circulation and predicted all-cause deaths using SARS-CoV-2 weekly percent positive as a covariate were modelled by age group and including state as a random intercept. COVID-19-attributable unrecognized deaths were calculated for each state and age group by subtracting the expected all-cause deaths from the predicted deaths.
findingsWe estimated that 766,611 deaths attributable to COVID-19 occurred in the United States from March 8, 2020-May 29, 2021. Of these, 184,477 (24%) deaths were not documented on death certificates. Eighty-two percent of unrecognized deaths were among persons aged ≥65 years; the proportion of unrecognized deaths were 0•24-0•31 times lower among those 0-17 years relative to all other age groups. More COVID-19-attributable deaths were not captured during the early months of the pandemic (March-May 2020) and during increases in SARS-CoV-2 activity (July 2020, November 2020-February 2021).
interpretationEstimating COVID-19-attributable unrecognized deaths provides a better understanding of the COVID-19 mortality burden and may better quantify the severity of the COVID-19 pandemic.
fundingNone.
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